Netarsudil as a Predictor of Response for MicroPulse Transscleral Laser Therapy: A Pilot Study.

Ophthalmol Glaucoma

University of Missouri-Columbia School of Medicine, Columbia, Missouri; Department of Ophthalmology, Mason Eye Institute, University of Missouri, Columbia, Missouri; Department of Ophthalmology, Wilmer Eyes Institute, Johns Hopkins Medicine, Bethesda, Maryland. Electronic address:

Published: November 2022

Purpose: To investigate the role of netarsudil as an outcome predictor of MicroPulse transscleral laser therapy (MPTLT).

Design: Retrospective comparative study.

Subjects: Forty-seven eyes in 33 adult patients with glaucoma with a minimum of 1 month of follow-up after netarsudil treatment and 3 months of follow-up after MPTLT were included. Eyes receiving intraocular pressure (IOP)-lowering procedures in the interim were excluded.

Intervention: Ophthalmic eyedrops of netarsudil at 0.02%, followed by MPTLT treatment.

Main Outcome Measures: Correlation of success between netarsudil and MPTLT. Netarsudil success was defined as an IOP reduction ≥ 20% from baseline, whereas MPTLT success was defined as an IOP reduction ≥ 20% without additional IOP-lowering medications. Secondary outcomes included success rates, mean IOP reduction, adverse effects after each treatment, and netarsudil discontinuation rate.

Results: We found a positive correlation between the netarsudil response and the subsequent MPTLT response (odds ratio, 3.73; 95% confidence interval, 1.05-13.24; P = 0.041). Among netarsudil responders, 73.7% (14/19) of eyes subsequently responded to MPTLT, whereas among netarsudil nonresponders, 42.8% (12/28) of eyes subsequently responded to MPTLT (P = 0.037). From netarsudil, 44.4% of eyes were successful; from MPTLT, 55.3% of eyes were successful. The mean IOP reductions were 2.83 ± 5.74 mmHg from netarsudil and 3.15 ± 6.43 mmHg from MPTLT. Overall, the rate of netarsudil discontinuation was 55.3%. The most common reasons for netarsudil discontinuation were adverse effects (48.9%), followed by high cost (19.1%). The most common adverse effects to netarsudil were conjunctival hyperemia (48.9%) and blurred vision (8.5%). There were no adverse events reported after MPTLT. After MPTLT, 29.8% of eyes required additional IOP-lowering procedures.

Conclusions: The netarsudil response may serve as a predictive marker of the MPTLT response, with over 70% of netarsudil responders subsequently responding favorably to MPTLT in this study.

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http://dx.doi.org/10.1016/j.ogla.2022.06.005DOI Listing

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